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Home My WebLink AboutPermit Building 1980-7-15 (2) " (-,. . , ." . ~ ~ h INFORllATION UN!: 726-3753 Sq. Ftg, r.lain i3(ot(1!. ~q. Ftg. Access ...::l,7t" 'f Sq. Ftg. Other )(New Add Alter Rep. =:J'ence _Demo _ Cha nge/Use Other . LIINSPE(~rION LHlE CITY OF SPRINGFIELD 726-3769 . CmlBINATION APPLICATION/PERMIT Job Address ~'1577:, . Va IS Y 51 re.e. -f ~~;~G~~~~/~;: p.lt{1:/c Legal De5cript..i.'63, 1~- bZ- OS--I~ TCA.'i L~ Hater Heater cP!,?('.f-hc ~.' ,,-'---"-;--1"' -- --- Range elf'( l-1rI{:'~ ... d,ClOD-fMI,^'bV 'R>.'t"kJ./DV\tD~L/ Lot ~ JaluE of l'lorfj 00 Owner- kf_~f1t'-#; wyaH- .505'1" - Address ')J!::'"7Q I ..c:;:, fir A, d / -.5 ~ n J Phone Z<l,/>7,;", Builtiino Permit Info: Describe Hork(Le., ~, / ~ ~ , r. ~~ _-I, ,~/7 ~~~~, Familv Residence Hith Attached Garaoe) ,.if - '/~~~~~::=:~~'~;"'0L~":~"::..~~-':':=,~Z_.-;:::-'~~;:=_ ) , I N e..W Y'~S\rJEY\U0 \N;-hA I ConstructlOn Lender Ve...lv(JJ/J_~ Artm\Y)I~+$(\h()V\ oJ-\- o..c...hed ~(}\ir1.o.P.J Ii ' 'l-. \/ I "lJ' 'I. 31.( 2 - ~ v , .~.,ddress /500 Y G\.I e..y r::::.lve..vD't"...su/\~O Phone ~274 . . DESIGN TEAr.l (name) , '.. (addressY Build Single ,()$ C) a 6" o ~ (lics. no.) (exnires) (phone no.1 Primary OWIfl1JAr , St ructura 1 . Electrical , !1echanical CONTRACTORS (name) (address) (lies, no,) (expires) (ohone no, ) i ~ I I , Genera 1 II.' u, .::, 0 W I/)f' .'r a' Plumbino : Electrical , ~'echanica1 PLUf1B I NG ELECTRICAL MECHANICAL , , ! , NO.' , FEE 'CHARGE I NO. , """ 'rHARr:" NO, , 17"" " rHARr." Each single fixture Residence of V J?J(PL/ SQ. FT. ;l6'.0<: furnace/burner to BTU's Relocated building (new fix. additional) V- S.F. Residence (1 bath) Duplex (1 bath) each New circuits a1ts. or extensions Floor furnace and vent ;< 5,0, SERVICES, Recessed wall Soace heatpr and vpnt Hater service j le.ao I ITempOrary Construction IIJ,oO IChange in existing residence I Imu1tifami1y, comm. or Industrial I 10f amps. I I COt1f-l. / IND. FEEDERS I I Install/alter/relocate distrib, feeders I IOf amps. .~ I Appliance vent seoarate Stationary evap. cooler Vent fan with sinale duct lCd q..no Vent system apart from heating or A.C. Mechanical exhaust ~I ~" hood and duct 7voJJL. Wood stove/heater J Additional bath Sewer Storm Sewer Zone--R-/ Fi re Zone - Flood Plain~ I 3,s,o.,TOTAL CHARGES WHERE STATE Ul~ REQUIRES that the Electrical work be done by an'E1ectrical Contractor, the electrical portion o'f this permit shall not be va1.i.j until the label has been signed by, an Electrical' Supervisor andr~turned to the Building 'Division . '. . . I HAVE CAREFULLY EXA~lINED the completed application for 'permit, and do hereby certify that all information hereon is true and correct, and I further certify th~t,any .and all work oerformed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAf~CY will be made of any structure without the permission of the Building Division. I further certify that ,my registration ~/ith the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for 'exemption is noted hereon,' and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. NAt-1E(p1ease print) I'<e.nn~tln Wu A- \ 1 SIGflATURE,-y1 ~-A4L.Jy~.;;;tI. -\ FO~ OFFICE USE ONLY r Type/Const.V -N Units / So. Ftg. flain 13&1/ x ~~l/f) Value Bedrooms _II. Occy Load Sq. Ftg. Access.-S 7(, x 7, 'If) Value Stories a-Y) Occy Group...R- ~ Sq. Ftg. Other x Value '-----" ISSUANCE OF 'PF.Rt1IT )o.OQ ~ .3...., D TOTAL CHARGES ~,Gt1 TOTAL CHARGES , . DATJ- tS-8j TOTAL VALUATION BUILDING PER~1IT Charges and Surcharges I _ _ __ _ J..5J!..tJ.n t:. -0 iI .2, ... Fence _ __ _ _ _ ~:i .J!}f) J 1'10 D6mo _ ___ __ M..f)1'l 'Sidewalk 1. YO A/C Pavi ng d.3,.so I Curb Cut ------ -~'1'f~1 Plan Ck. 65%/B1da Plan Ck. 30%/Bldo Comm/lnd Per Fee Res Per Fee Systems Development Charge (1.5%) , ~ ~ -4..5 3~ pot-- PLW1BING PERMIT Charges and Surcharges ELECTR I CAL PERlm Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges TOTAL d5'1~~ 3/7. W l . Total Comb. Permit . ,.\ , ') Vi. , , I~: .--~ .. .. . .:' -,J.. -~ . ~' '-,... COMBINATION APPLICATION/PERMIT (CAP) . J' , (Ii , t :f.......\ ~ .1 ,. \ " PERMIT VALIDATION , I. Applicant to furnish A. Job Address B. Legal Description " 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, 2nd Addition to Springfield Estates ~. Name, etc. of owner and construction lender D. Energy Sources ,1. example- heat/electrical ceiling/or forced air qas ,. 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check new - if addition, check add, etc. F. Building permit information: 1. example - construct single family house with an attached garage 2, example - remodel existing garage into family room 3. example - convert single family residence into restaurant (change of use) , G. Value of work as defined in Section 303 (a) of the Structural Specialty Code H. DES I GN TEAt.' AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. II, Abbreviated Plumbing, Mechanical, & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedules have been abbreviated 2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the full schedules ' C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be delivered to the electrical cOntractor for signature by his electrical supervisor. The general contractor is not authorized to sign the electrical label. Applicant to sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Staff wi 11 prepare a type written copy and return it to the 'applicant at the time the actual permit is issued for his signature. Fees and Charges Plan check fees are due and payable at the time of the application, and no plans will be processed until these fees are paid. All other fees and charges are due and payable when the permit is issued. . ," .. , ,',1,\ III. IV. V. FOR OFFICE USE ONLY Permit Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: a:; ~.c;~ ~ 4lWd_ 4f"."rf'.p ~ ~) ~-f,~) A2J.~tfl. 711/7./, It:j, /979 I IF. I(I? ., ..AL.~ ", " '.. , . ... Permit applicant exempt,from registr~{Jon with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature a "" date 7 -15"- ~o . ,-;7' 1.1 CITY OF SPRINGFIELD ~, COMBINATION APPLICATION/PERMIT ~ ~ I r' ErlERGY SOURC,ES: +/1(. Heat (>.P r/illl/i ",,/.?CTV/[ / , " . \-Jater Heater:,' ,.::'/,f/..,.-h( iJ . Ranqe r?/i'( 1-;/'1(_ ( 1 "_' INSPECTION LINE 726-376g ." 4 . ..f.' " .. Job Address tf577 .OL.-\/~S 1 5 IF-e. e. -f Legal Description ,~- 02.- OS-/.~ 'To..." L(',+ . "," t ~q 00- M !'v\IC:::>Y~ ",'h+ I~)V\ II":)~L/ Let .e, O ... . .. , I wner kp_ n f1( f11 \N va TT , n 7';'" Address .2-<)7C.? J... .:::sire. -?'.f ,- _ ?0/-;) Phone ~'.;f~C) I --J_':' . -1-. . _ Construction Lende'r \ I,:, _,!,.~....,. './,1,[ A! ' " L' v '.' / . --, , 1\ ffi \ If' I ~-;\'rn \ \ ('N\ - ' 3~~-, .,ddr~ss 1:500 V<::\I ieV" i<t,;,:..y'L;y"SJ\}.;... Phone 9,:!.7'I , ,\ DESIGfJ TEN' (name) ( ,.'-" (address) Primary 0 \^'/ V1;J }r ' Structural' Electrical !1echanical CONTRACTORS (name) I ' 'General ~ O\NiI)P\' (address) Plumbino ; Electrical , ~,1echa n i ca 1 PLUfm I fIG , ValuE of l'lor~j cO .:p .37; 5'-/'1, -' Buih~inq Permit Info: Descr,be Hork(;..e.. Familv Residence Hith Attached ~araqe) N. F:..;"('oJ \('.(' Sl()e..Y\CQj W I ..h~ \-\ '^ A C\I i O-.C, i t'LA i ELECTRICAL rm. CHARGE NO. I Residence of V- J ~(P4 FEE Each single fixture Relocated' building (new fix, additional) New circuits alts. or extensions, I .---i S. F. Res i dence ~ I (] ba th) , I Duplex (l bath) I IAdditional bath Hater service each 1;<5,a, I IID,ao SERVICES Sewer I I I I I Of I Storm Sewer SQ. FT. amps. COMM./IND. FEEDERS I Install/alter/relocate I' distrib, feeders Of amps.1 I I I .' .' INFORr'ATlON UNt. 726-3753 ... .-. ~q. t tQ. r'la i n I ~;<, (;7 'I'4J ~q. Ftg. Access._~7f-,. f Sq. Ftg. Other )(f~ew__Add__Alter ~ep, =:!ence__Demo__Change/Use Other . \:R; (l '-' n \" () ['I '-' Build Single ~ 00. 'r o-'Q~ " '-' v (lies. no.) (lies, no.) FFF rHAR(;F NO. ~~, O{;l (exoires) (ohone no. I I Temporary Construction I Change in ~xisting I residenc~ multifamily, comm. or Industrial I I/alonl I I I I .~ I I I / I (exoires) (ohane no, ) MECHANICAL rFF rfIAR(;4 furnace/burner to BTlI's Floor furnace and vent ' ~ Recessed wall Soace heatpr and vpnt I I I I I I 1 c(} I t;'. tV I I l'i, I Appliance vent seoarate Stationary evap. cooler . Vent fan wi th sinole duct Vent system apart from heating or A.(.. Mechanical exhaust hood and duct Wood stove/heater I SSUANCE OF PFRr1I T In.on /}.3..sD thi s permit TOTAL CHARGES 3S / OC. TOTAL CHARGES 3.s. (Zi, TOTAL CHARGES WHERE STATE UHREQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXA~1INED the completed application for permit, and do hereby certify'that all information hereon is true and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City of Soringfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exemot the basis for exemotion is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.' , . ? SIGWITUREV ~/A7.e;d>!/~ I;;t/ . , ' USE o;~L Y v' NAME(please print) 1~eJ\ne/th W~ A:tt- Zone p_ / Fi re Zone - Flood Plain~ FO~ OFFICE I Tyoe/Const.-vr --IV Bedrooms i,( Stories ~ Units Occy Load Occy Group1- ~ BU I LDING PERmT Charges and Surcharges I , 'PlanCk. _____J...51Lan 65%/Bldo Plan Ck. to.oll 30%/Bldo _ _ _ _ _ _ .~~4..J!2rl Fence 1" q II D6R10 ..J._ . _ _ _ _ _ _ _ _ .3..s.....f)11 Sidewa 1 k I. SID I A/C '''''g _ _ _ _ _ _ .9l.3,So_ Curb Cut 17iJ Comm/lnd Per Fee Res Per Fee D/l.TJ- lIS - Zj Sq. Ftg. r1ai n j 314/1" x ;;, ~ I/o Value Sq. Ftg. Access 57(" x ],lIn Value Sq. Ftg, Other x Value TOTAL VALUATION .3 3~_~ /. 4tO ~~ 3 ~ S'/<Ir{JO S~3. /{, I Sys terns Deve 1 opmen t ' Charoe (1.5%) ,;, /:530 po{; .L.J..:., . .-- PLW1BING PERMIT Cha rges and Surcha rges ELECTRICJ!.L PERf~1T Charges and 'SurCha rges r1ECHANICAL PERf1IT Charges and .surcharges I I I I Tota 1 l_oT' 'L 111\ Comb. Permit ~ S '/,,;, ~ r $/7, '1'1- ; . , '.'." .-' - . ' COMBINATION APPLICATION/PERMIT (CAP) III. V. FOR OFFICE USE ONLY ~ .. , I \ ..' -t ~_... . 53986. ... PERMIT VALIOATI01I .' CITY OF S,PRINGFIELD - 1 ~ \ . I. Applicant to furnish A. Job Address ,B. Legal Description 1.' example- Tax Lot 100, Lane County Map RE ('" 17 03 43 2. examole- Lot 1. Block 3, 2nd Addition te Springfield Estates C, Name, etc. of owner and construction lender ( D. Energy Sources 1. example- heat/electrical ceiling/or fore 2. example~ waterheater/electrical/or solar E. Square footage or valuation, etc. 1. examo 1 e- 1250 sq. foot house , 500 sq. fe cqa 2. example- if new project, check new - if check add, etc. F. Building permit information: ~ 1. example - construct single family house (h attached garage 2, examole -remodel existing garage into 1 3. examole - convert single family residene restaurant (change of use) , ,( G. 'Value of work as defined in Section, 303 (a) Structural Specialty Code H. DESIGN TEAr'l AND CONTRACTORS To avoid design or construction delays, Buil ~:9 Division Staff must be able to contact appre persons regarding design information or job corrections, etc. II. Abbreviated Plumbing, Mechanical, & Electrical ~ E9Li A. Except where blank spaces occur in the descr portio~ of the Mechanical and Electrical Sct the applicant need fill-in only the No. BOXE B tFolt1hep1aPbP~opri~ltehit~m(sl) tOdbeE1inst~l1e1dS (. . u um lng, ,.ec anlea , an ectrlca' e' are available at the Building Division 1. To conserve space oh the permit form thE have been abbreviated ( 2. If theitem(s) to be installed are not e the abbreviated schedules you should cor full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FE (A~ CHARGES ON THE SCHEDULES " ' D. As noted on the CAP~ the label must be d~li\ electrical contractor for signature by his E supervisor. The general contractor is not c to sign the electrical label. - , Applicant to sign and date Whenever possible, the initial application will a worksheet only. Where possible, Building Divi eh wi 11 prepa re a type written copy and return it 1 ...' BY." appl icant ,at the time the actual permit is iSSUE ( signature. , _ IV. Fees and Cha rges .- Plan check fees are due and payable at the time \~. application, and no plans will be processed unt~ fees are paid. All other fees and charges are due and payab 1 e I"lhen the permi tis issued. (6r Amount Received City Hall Springfie.ld.. Oregon Department of Public Works OFFICIAL RECEIPT No.8, Date (-'/5 191;0 Rec'd From Kf OOf?i:h I Address 1~ nL::5fy._ pt, I5/00 lo'.O~ 3r:j 00 - t 4(] .In. 00 . Ll-O L r;=, 00 l.a:) 23. F)() cf4 ~/~3, IV, 4 4 (~f~ . 6) Received For:' ./ , , ~C-)n I~ P\~ ~l? In yp \ Lt I 4S 40//') 14r4~ . qQ]() , crjJ 1-fP 4DJ(~ .<;or , R17 Co ..,.... . e. ~' ~ rt' c C' . AUTHORIZED SIGNATURE SHIEL TON'TURNBULL PRINTERS' EUGENE. OR 117401 DBall-S ( '. ( ( ( PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ~~;~~~o Q/)~ M- ~/iA-' ~~~'.~<~ ~,~ . I - - -- if I () 0 (/ ~) ~, gA~~:"') ~J.~61 nO/i /9, /979 I Y . ~-~- , . .... Permit Clerk Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: . signature a . . '"" name ,0 . .' ~ .' . ' . . date 7--/S"- <;f0